Headaches can be truly incapacitating. Up to 90% of the population will suffer from the effects of headache at some stage, often leading to time off work and the need to consult a general practitioner or health professional. Physiotherapists are frequently a primary contact for sufferers. Headaches can be due to a multitude of factors, and only a sub-group of patients will be aided by our treatments. Typically, this will be those with neck related or 'cervicogenic headache' or those with a cervical (neck) contribution to their tension headaches or migraines. The last 15-20 years has seen significant research into this specific type of headache, with some evidence now suggesting up to 36% of headaches may have a cervicogenic input. There is little doubt now that the neck is commonly involved in the generation of head pain, yet it sometimes goes unrecognised by medical practitioners due to a combination of confusion regarding its symptoms, and a historical focus on other forms of headache.

Symptom overlap between true migraine (which is a vascular condition), tension, and cervicogenic headaches is encountered frequently. In turn, each of these may have a variety of causative factors; breaking that cycle and preventing long term chronicity of the problem are challenges for us as Physios. We aim to identify those patients for whom Physiotherapy treatment is likely to be of benefit, and to screen those for whom it is unlikely to work - we can treat many things, but NOT everything! Importantly though, the current depth of research on headaches now actively recommends that if you suffer from them, a trial of manual therapy and exercise treatment should be one of your first treatment steps.

Our staff at Belmont City Physiotherapy Clinic can provide you with the right advice and the best treatment for neck related headaches, many of us having had first hand experience of them ourselves.

Characteristics of Cervicogenic Headache

Moderate-severe, non throbbing pain.

• Pain usually starts in the neck.

• Tenderness on palpation of the upper neck region of the symptomatic side.

• Episodes of varying duration, lasting from hours to days.

• Constant but fluctuating pain; continuous symptoms with periods of heightened pain.

• Unilateral head pain without side shift.

• May be accompanied by nausea, sensitivity to light and sound, dizziness, blurred vision, and difficulty swallowing.

Evidence Based Treatment

• Manual Therapy combined with therapeutic exercise provides short term and long term relief from mechanical neck disorders

• Early manual treatment accelerates improvement, especially if combined with exercise

• Multi-modal treatments are more effective at reducing neck pain and headaches than a single modality approach

• A Cochrane review concluded that physical therapies, inclusive of spinal manipulation and mobilisation in conjunction with low intensity endurance neck exercises are effective treatments for chronic recurrent headaches, including migraine. There is little risk of serious adverse effects from this treatment . It concluded that a therapeutic trial of manual therapy should be considered for all long term recurrent headaches, not just those considered purely cervicogenic.

• Medication alone is rarely successful in the management of cervicogenic headache. Sufferers often use (and may overuse) analgesics and anti-inflammatory medications in order to gain short term relief from their pain. It can be a 'slippery slope' where increasing use of medication yields diminishing relief, so sufferers end up taking either more medication or stronger types of medication just to get by. The cautious use of these is warranted, but you should consult your GP to discuss the options available to you first. Sometimes, a carefully combined regime of complementary classes of medications (e.g. tricyclic antidepressants, anti-epileptics, muscle relaxants) may be more effective than using one individual medication. Importantly, the use of medication provides a ‘window of opportunity’ in which greater gains can be made with physical therapy and other lifestyle changes.